Cardiopulmonary Resuscitation With Chest Compressions During Sustained Inflations

Schmölzer, Georg M.; O’Reilly, Megan; LaBossière, Joseph; Lee, Tze-Fun; Cowan, Shaun; Qin, Sharon; Bigam, David L.; Cheung, Po-Yin

doi:10.1161/circulationaha.113.002289

Cited by 92 publications

(100 citation statements)

References 53 publications

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“…Further studies on preterm lambs have demonstrated that the SI technique also increases intrathoracic pressure without impeding blood flow [16]. In the resuscitation of asphyxiated newborn piglets, we recently reported that passive ventilation during CC, achieved by CC+SI, significantly improved hemodynamics, minute ventilation, and time to ROSC compared to the current approach of 3:1 C:V CPR [9]. However, that previous study used a CC rate of 120/min instead of the currently recommend CC rate of 90/min; this could have contributed to the improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study using a porcine model of neonatal asphyxia, we reported a novel chest compression technique using CC during sustained inflations (CC+SI), which resulted in a significant improvement in the return of spontaneous circulation (ROSC), minute ventilation, and cardiovascular parameters versus the currently recommended 3:1 compression:ventilation ratio (C:V) for CPR [9]. However, this study performed CC+SI at a much higher CC rate (120/min), which could have contributed to the better outcomes [10].…”

Section: Introductionmentioning

confidence: 99%

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Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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“…These studies suggest that during neonatal CPR, different C:V ratios do not improve outcomes and might not be the optimal CC approach in newborn infants. In comparison with the recommended 3: 1 C:V, combining CC with sustained inflation has been shown to be more effective in improving ROSC in piglets [15, 22-24], but not in lambs [25]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

et al. 2018

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Background: High-quality chest compression is essential during neonatal cardiopulmonary resuscitation (CPR). However, the optimal compression to ventilation ratio (C:V) that should be used during neonatal CPR to optimize coronary and cerebral perfusion while providing adequate ventilation remains unknown. Objective: We hypothesized that different C:V ratios (e.g., 2: 1 or 4: 1) will reduce the time to return of spontaneous circulation (ROSC) in severely asphyxiated piglets. Methods: Thirty-one newborn piglets (1–4 days old) were anesthetized, intubated, instrumented, and exposed to 50-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into 4 groups: 2: 1 (n = 8), 3: 1 (n = 8), 4: 1 (n = 8) C:V ratio, or a sham group (n = 7). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: Thirty-one piglets were included in the study, and there was no difference in the duration of asphyxia or the degree of asphyxiation (as indicated by pH, PaCO₂, and lactate) among the different groups. The median (IQR) time to ROSC was similar between the groups with 127 (82–210), 96 (88–126), and 119 (83–256) s in the 2: 1, 3: 1, and 4: 1 C:V ratio groups, respectively (p = 0.67 between groups). Similarly, there was no difference in 100% oxygen requirement or epinephrine administration between the experimental groups. Conclusions: Different C:V ratios resulted in similar ROSC, mortality, oxygen, and epinephrine administration during resuscitation in a porcine model of neonatal asphyxia.

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“…Although more information is needed before this technique can be translated to the clinical arena, Schmölzer et al 11 provide critical information regarding a novel change in delivery of CPR that may provide an answer to that long-vexing conundrum of how to improve perfusion without sacrificing essential ventilation during asphyxia-induced cardiovascular collapse of the newborn. Such an answer could be the key to improving the often devastating outcomes after neonatal CPR.…”

Section: Article See P 2495mentioning

confidence: 99%

Improving Neonatal Cardiopulmonary Resuscitation Hemodynamics

Wyckoff

2013

Circulation

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Editorial 2468C hest compressions are rarely needed in newly born infants, with an estimated occurrence of 0.08% for near-term and term deliveries; however, the consequences of a hypoperfused state on the brain and other organ systems can be devastating.1 Newborns that require prolonged cardiac compressions with no signs of life beyond 10 minutes are at risk for exceptionally poor outcomes, with up to 83% mortality and 77% severe disability noted in survivors.2 Although initiation of therapeutic hypothermia appears to have some advantage for cardiopulmonary resuscitation (CPR) recipients who survive the delivery room, 3 optimization of the hemodynamics of neonatal cardiac compressions during CPR remains critical. Article see p 2495The infrequent use of cardiac compressions for newborns in the delivery room has impeded the design and completion of rigorous investigations to determine the most effective neonatal cardiac compression methodologies. 4 The unique physiology of the newborn with initially fluid-filled alveoli, the need to transition from fetal to newborn circulation, the open ductus arteriosus, and the frequent presence of severe asphyxia as the cause of cardiovascular collapse add dimensions that cannot be accurately tested in adult or even pediatric patients or models. Adults most frequently receive CPR for cardiac events, such as ventricular fibrillation. Immediately after cardiac arrest, the aortic oxygen and carbon dioxide concentrations are close to the pre-arrest state.5 With initiation of CPR, the blood perfusing the coronaries has adequate oxygenation and pH. Thus, the problem in cardiac arrest is primarily the lack of blood flow rather than the content of the blood. For this reason, resuscitation algorithms for cardiac arrest focus predominantly on providing continuous, uninterrupted compressions with much less emphasis on ventilation. Adequate oxygenation and ventilation can continue without rescue breathing for several minutes because of chest compression-induced gas exchange and spontaneous gasping during compressions in victims of sudden cardiac arrest. [5][6][7] This is quite different from resuscitation after asphyxia-induced arrest. Animal models of asphyxia clearly demonstrate that a combination of chest compressions and ventilations generates better outcomes and survival than resuscitation with ventilations or compressions alone, 8,9 particularly during prolonged resuscitation. 10 During asphyxia, blood continues to flow but with ever-increasing hypoxemia, hypercarbia, and acidemia until the heart runs out of energy substrate and becomes severely bradycardic and eventually asystolic. Thus, it is not surprising that ventilation is essential to reversing asphyxial arrest.The recent work by Schmölzer et al 11 appearing in this issue of Circulation uses a neonatal model of hypoxia/asphyxia to investigate new ways of enhancing blood flow during neonatal CPR while maintaining adequate ventilation. Although not a perfect model given that the animals already had posttransitional physiology, t...

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Cardiopulmonary Resuscitation With Chest Compressions During Sustained Inflations

Cited by 92 publications

References 53 publications

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

Improving Neonatal Cardiopulmonary Resuscitation Hemodynamics

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